Gynecology Flashcards
Reproductive tracts develope from which two ducts
Wollfian (male) and Mullerian (female)
average adult uterine dimensions
8cm(length) x 3cm (AP) x 5cm(trans)
(Tips: 3+5=8)
measurements of endometrium based upon phases of the menstrual cycle
-Menses (1-4mm)
-Proliferative (6-10mm)/Eva’s notes 12-13mm
-Secretory (7-14mm)/ Eva’s notes 18-22mm
“Tip: 1+3=4 (Menses); 6+4=10 (Proliferative); 3+4=7+7=14 (secretory)
average adult ovarian length
3cm (length) x 2cm (AP) x 1cm (trans)
Hormone that triggers ovulation
LH surge
hormone which makes follicles in ovary grow
FSH
layers of the uterus
-endometrium
-myometrium
-permetrium/serosa
4 sections of the uterus
-Fundus
-Body/corpus
-isthmus (LUS more commonly used)
-cervix (external os, fornix, internal os)
where does fertilization normally take place
ampulla of fallopian tube
normal location of a fertilized ovum to implant
within the upper 2/3 of the uterus
sections of the fallopian tube
-interstitial
-isthmus
-ampulla
-infundibulum
-fimbria
female reproductive muscles (4)
-Iliopsosa: from the iliac crest to the greater trochanter of the femur
-Obturator internus: parallel to the lateral walls of the pelvis
-piriformis: posterior pelvis
-levator ani: posterior pelvis
the two spaces with the FMS
-anterior cul de sac (vesico uterine space): is posterior to the bladder and anterior to the uterus
-posterior cul de sac (Pouch of Douglass): is posterior to the uterus and anterior to the rectum
ligaments of the FMS (6)
“BRO I C U”
-broad Lig.
-round Lig.
-ovarian Lig.
-infundibulopelvic lig.
-cardinal lig.
-uterosacral lig.
Shadowing off of the fornices at the cervix is termed
Fu Man Chu
most common congenital malformation of the uterus
bicornuate uterus:
-uterus bicornis unicollis (two uterine horns and one cervix)
-uterus bicornis bicollis (two uterine horns and two cervices)
the different angles of the uterus
-anteverted, anteflex
-retroverted, retroflex
Blood supply to FMS
-ovarian A./V. (Branch from AO)
-Uterine A. (Branch from internal iliac A.)
-arcuate vessels
the four types of PID (Pelvic Inflammatory Disease)
-Salpingitis: inflammation of fallopian tubes
-Pyosalpinx: Pus filled due to virual, bacterial, or fungal infection
-Hydrosalpinx: fluid filled fallopian tubes
-TOA (Tubo Ovarian Abscess) : acute vs chronic
nulliparous
no births
What days of the ovarian cycle is the follicular phase
days 1-13
what day of the ovarian cycle is ovulation
day 14
what days of the ovarian cycle is the luteal phase
days 15-28
what are the levels of estrogen and progesterone during the ovarian cycle
-follicular phase: estrogen increased and progesterone decreased
-luteal phase: estrogen decreased and progesterone increased
what days of the uterine cycle is the menses
days 1-6 (uterus sheds old lining)
what days of the uterine cycle is the Proliferative phase
days 7-14 (mature ovum is ready for fertilization)
what days of the uterine cycle is the secretory phase
Days 14-28 (uterus is ready for implantation)
what are the five different uterine fibroids
-intramural fib.
-subserosal fib.
-submucosal fib.
-pedunculated fib.
-cervical fib.
after ovulation what happens to the Graffian follicle and which hormone increases
the mature graffian follicle releases the cumulus oophorus at day 14, and then becomes the corpus luteum. The corpus luteum at day 15 secretes progesterone and continues increasing
what is the formula to get the ovarian volume
volume = Length x height(AP) x width x 0.523
what happens to the uterine size after menopause
reduces significantly in size assumes a prepubertal shape
premenarchal
Before menstruation
if the endometrium and its three layers are visible in a sonographic image, what does that mean
the patient is in the Proliferative phase of her uterine cycle
Difference between the true pelvis and false pelvis
-true pelvis is a bowl shaped cavity aligned posteriorly/inferiorly within the skeletal frame
-false pelvis is the more superior aspect of the pelvic cavity
a benign cyst in the ovaries, that is fluid filled (simple or complex) from the graffian follicle, is larger than 3cm in size, and normally clears up between 3-6months
cyst-adenoma aka functional ovarian cyst
four types of complex ovarian cyst’s
-hemorrhagic cyst (chocolate cyst)
-TOA
-corpus luteal cyst
-cyst-adenocarcinoma
a cyst filled with cells from different layers of an undeveloped fertilized ovum; inside the cyst will have hair, fat, teeth
dermoid cyst
small benign cysts located in the cervix
nabothian cysts
multiple cysts on both ovaries associated with masculinizing findings and affects young women; “string of pearls”
Polycystic Ovarian Syndrome (PCOS) aka Stein Leventhal Disease
Definition:
Benign mucous-filled cysts that form in the cervix due to blocked cervical glands.
Also called epithelial inclusion cysts.
Key Ultrasound Findings:
Small, anechoic or hypoechoic cystic structures in the cervix.
Well-defined with thin walls.
No vascularity on Doppler imaging.
May be single or multiple in number.
Symptoms:
Asymptomatic in most cases.
Occasionally found during routine pelvic ultrasound.
Causes:
Form due to squamous metaplasia blocking cervical mucus glands.
Often seen in multiparous women.
Clinical Significance:
Benign and do not require treatment unless symptomatic.
No association with malignancy.
Treatment:
None required unless large and causing discomfort.
If symptomatic, cyst drainage or electrocautery may be performed.
Nabothian Cysts
Definition: A common benign ovarian tumor derived from germ cells, containing tissues from all three germ layers (ectoderm, mesoderm, endoderm).
Key Ultrasound Findings:
Complex appearance with both cystic and solid components.
Echogenic areas that may produce acoustic shadowing due to calcifications or hair.
“Tip of the iceberg” sign: highly echogenic mass with posterior shadowing obscuring deeper structures.
Symptoms: Often asymptomatic but can present with abdominal pain if torsion or rupture occurs.
Treatment: Surgical removal, especially if symptomatic or to prevent complications.
Mature Teratoma (Dermoid Cyst)
Definition: A benign epithelial ovarian tumor lined with serous (clear) fluid-producing cells.
Key Ultrasound Findings:
Unilocular or multilocular cystic mass with thin, smooth walls.
Anechoic content with possible thin septations.
Symptoms: Typically asymptomatic; larger masses may cause pelvic discomfort or pressure symptoms.
Treatment: Surgical excision, especially if large or symptomatic
Serous Cystadenoma
Definition: A benign ovarian tumor characterized by mucin-producing epithelial cells.
Key Ultrasound Findings:
Large, multilocular cystic mass with varying echogenicity due to mucinous content.
Thin septations; internal echoes may be present.
Symptoms: Abdominal distension, pelvic pain, or pressure effects on adjacent organs.
Treatment: Surgical removal to prevent potential complications like rupture.
Mucinous Cystadenoma
Definition: A rare, benign ovarian tumor composed of transitional (similar to the lining of the urinary tract) cells. Most common in post menopausal woman 50+
Key Ultrasound Findings:
Solid, hypoechoic mass with well-defined borders.
May contain calcifications causing acoustic shadowing.
Symptoms: Usually asymptomatic; may present with nonspecific pelvic pain.
Treatment: Surgical excision; typically has an excellent prognosis.
Brenner Tumor
Definition: A benign ovarian stromal tumor arising from theca cells, often associated with estrogen production.
Key Ultrasound Findings:
Solid, hypoechoic (dark) mass; may have posterior acoustic attenuation due to fibrous content.
Occasionally shows cystic degeneration.
Symptoms: Postmenopausal bleeding or endometrial hyperplasia due to estrogen secretion.
Treatment: Surgical removal; monitoring for estrogen-related endometrial changes.
Theca Cell Tumor (Thecoma, Fibrothecoma)
Is a rare ovarian sex cord-stromal tumors that arise from GRANULOSA cells, which are responsible for producing ESTROGEN. This can cause endometrial hyperplasia (abnormal thickening of the endometrial lining) or cancer.
Ultrasound Findings:
- Can look solid, cystic, or a mix of both.
- Can show bleeding or scarring.
Symptoms:
- Irregular uterine bleeding.
- Breast tenderness.
- Precocious puberty (abnormal growth of secondary sex characteristics) in very young girls.
Treatment:
- Surgery to remove the tumor.
- Long-term follow-up because it can come back later.
Granulosa Cell Tumors
Definition: A rare tumor composed of both germ cell and stromal elements, often associated with disorders of sex development. It presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes.
Key Ultrasound Findings:
Solid mass; may contain calcifications.
Often bilateral.
Symptoms: May present with virilization or ambiguous genitalia.
Treatment: Surgical removal due to potential for malignant transformation.
Gonadoblastoma
Definition: A rare ovarian stromal tumor that produces ANDROGENS, leading to virilization.
Key Ultrasound Findings:
Solid, hypoechoic mass; may have cystic components.
Well-defined margins.
Symptoms: Signs of virilization such as hirsutism (hair growth on women of face, chest, back), deepening voice, and amenorrhea.
Treatment: Surgical excision; monitoring for hormonal effects.
Sertoli-Leydig Cell Tumor (Androblastoma)
Definition: Malignant counterpart of cystadenomas; most common ovarian malignancy.
Key Ultrasound Findings:
Multilocular cystic mass with thick septations and solid components.
Papillary projections and internal vascularity.
Ascites may be present, indicating peritoneal spread.
Symptoms: Abdominal distension, pelvic pain, bloating.
Cystadenocarcinoma (Serous or Mucinous)
Definition: Aggressive ovarian cancer with no specific differentiation.
Key Ultrasound Findings:
Solid, irregular mass with necrotic areas.
High vascularity on Doppler imaging.
May be associated with ascites.
Symptoms: Non-specific; often presents late.
Undifferentiated Adenocarcinoma of ovaries
Definition: is a type of endometrial cancer, which originates in the lining of the uterus (the endometrium). It is the most common type of endometrial carcinoma and is generally associated with a better prognosis compared to other types of endometrial cancer. It is often diagnosed in women who are postmenopausal or in those with a history of hormone imbalance, obesity, or other conditions that increase estrogen levels.
Key Ultrasound Findings:
Mixed cystic and solid mass.
Irregular borders, papillary projections.
May mimic endometrioma, but with atypical vascularity.
Symptoms: Abnormal uterine bleeding, pelvic pain.
Endometrioid Carcinoma
Definition: Aggressive malignancy, linked to endometriosis.
Key Ultrasound Findings:
Unilocular or multilocular mass with solid nodules.
Highly vascular solid components.
May contain hemorrhagic or necrotic areas.
Symptoms: Pelvic pain, bloating, early metastasis.
Clear Cell Carcinoma
Definition: Most common malignant germ cell tumor, often in younger women in their teens and twenties.
Key Ultrasound Findings:
Solid, lobulated mass.
Highly vascular with internal blood flow.
May contain areas of hemorrhage or necrosis.
Symptoms: Pelvic pain, rapid growth, possible hormonal effects.
Dysgerminoma
Definition: Malignant counterpart of mature teratoma (dermoid cyst).
Key Ultrasound Findings:
Complex mass with solid and cystic areas.
Calcifications may be present.
Heterogeneous appearance due to mixed tissue types.
Symptoms: Abdominal pain, rapid growth.
Immature Teratoma
Definition: Rare teratoma variant composed mainly of thyroid tissue. It can sometimes produce thyroid hormones even though it is located in the ovaries.
Key Ultrasound Findings:
Complex cystic and solid mass.
Increased vascularity similar to thyroid tissue.
May show signs of hyperthyroidism (increased metabolism).
Symptoms: Hyperthyroidism symptoms, pelvic mass.
Struma Ovarii
Definition: Highly malignant germ cell tumor, secretes hCG.
Key Ultrasound Findings:
Irregular solid mass with vascular flow.
Hemorrhagic and necrotic areas.
Symptoms: Amenorrhea, vaginal bleeding, elevated β-hCG.
Choriocarcinoma
Definition: Aggressive teratoma with immature elements.
Key Ultrasound Findings:
Heterogeneous solid-cystic mass.
Calcifications possible.
High vascularity, may mimic immature teratoma.
Symptoms: Rapid growth, abdominal pain.
Teratocarcinoma
Definition: Highly malignant germ cell tumor, secretes AFP.
Key Ultrasound Findings:
Solid mass with vascularized septations.
Central necrosis may be present.
Increased Doppler flow (high vascularity).
Symptoms: Rapid growth, abdominal pain, elevated AFP.
Endodermal Sinus Tumor (Yolk Sac Tumor)
Definition: Metastatic ovarian tumor, usually from gastric cancer.
Key Ultrasound Findings:
Bilateral solid masses.
“Moth-eaten” cystic areas due to necrosis.
Highly vascularized.
Symptoms: Abdominal pain, weight loss, history of GI malignancy.
Krukenberg Tumor
Definition: Ovarian involvement of systemic lymphoma.
Key Ultrasound Findings:
Bilateral solid ovarian masses.
Homogeneous, hypoechoic appearance.
No significant necrosis.
Symptoms: Systemic lymphoma symptoms (fever, weight loss).
Lymphoma
Definition: Estrogen-secreting tumor, risk of endometrial cancer.
Key Ultrasound Findings:
Solid or cystic-solid mass.
May contain hemorrhagic areas.
Hypervascular on Doppler imaging.
Symptoms: Irregular bleeding, breast tenderness, endometrial thickening.
Granulosa-Theca Cell Tumor
Definition: Androgen-producing tumor, leads to virilization.
Key Ultrasound Findings:
Solid hypoechoic mass.
Well-circumscribed borders.
May show cystic degeneration.
Symptoms: Hirsutism, deepened voice, amenorrhea.
Androblastoma (Sertoli-Leydig Cell Tumor, Arrhenoblastoma)
